PNLE MEdicaL-SurgicaL NurSiNg rEviEwEr
2025/2026 – advaNcEd aduLt HEaLtH
coMPrEHENSivE ExaM PrEP | HigH-YiELd PracticE
QuEStioNS witH vErifiEd aNSwErS & dEtaiLEd
ratioNaLES | PHiLiPPiNE NurSiNg LicENSurE
ExaMiNatioN (Board ExaM) SuccESS guidE
1. Q1 — A 62-year-old man with chronic stable angina reports new chest pain at rest
lasting 20 minutes. Which immediate action should the nurse take first?
A. Administer sublingual nitroglycerin and reassess in 5 minutes
B. Obtain a 12-lead ECG and notify the physician
C. Give chewable aspirin 325 mg and begin oxygen at 2 L/min via nasal cannula
D. Start an intravenous (IV) line and draw cardiac enzymes
Correct answer: B. Obtain a 12-lead ECG and notify the physician.
Rationale: A 12-lead ECG is the priority to determine ischemia/infarction and guide immediate
treatment; notify physician promptly. While nitroglycerin and aspirin are often given rapidly,
ECG to identify ST-elevation/arrhythmia takes precedence in new rest pain.
2. Q2 — A postoperative patient has been receiving opioids and reports respiratory
rate 8 breaths/min with decreased responsiveness. What is the nurse’s priority
action?
A. Stimulate the patient and continue current monitoring
B. Administer naloxone per protocol and call the physician
C. Increase supplemental oxygen to 6 L/min via mask
D. Place the patient in the lateral recovery position and observe
Correct answer: B. Administer naloxone per protocol and call the physician.
Rationale: Opioid-induced respiratory depression with bradypnea and decreased responsiveness
is life-threatening; administer naloxone per protocol and get prescriber involved. Simultaneous
airway support/oxygen may be needed.
3. Q3 — A client with type 1 diabetes is admitted with polyuria, polydipsia, abdominal
pain, and Kussmaul respirations. Serum glucose is 520 mg/dL, pH 7.18, and serum
potassium 5.2 mEq/L. What should the nurse anticipate first?
A. Begin IV regular insulin infusion after establishing IV access
B. Give oral potassium to lower serum potassium
C. Start IV 0.9% sodium chloride bolus and then insulin infusion
D. Administer sodium bicarbonate to correct acidosis
Correct answer: C. Start IV 0.9% sodium chloride bolus and then insulin infusion.
,Rationale: In DKA, aggressive fluid resuscitation with isotonic saline precedes insulin to restore
perfusion; insulin then lowers glucose and shifts potassium intracellularly. Potassium
management follows monitoring; bicarbonate is reserved for severe acidosis (pH <6.9).
4. Q4 — A patient with heart failure has sudden weight gain of 4 kg in 3 days,
increased dyspnea, and bibasilar crackles. Which intervention should the nurse
implement first?
A. Administer scheduled oral furosemide and monitor urine output
B. Place the patient in high-Fowler’s position and give oxygen
C. Restrict fluids and start low-sodium diet education
D. Call the healthcare provider for an order for IV diuretics
Correct answer: B. Place the patient in high-Fowler’s position and give oxygen.
Rationale: Acute pulmonary congestion requires immediate measures to improve oxygenation
(upright position and O2). After stabilization, diuretics (often IV) should be given promptly; call
for IV diuretics if not already ordered.
5. Q5 — A client with COPD is receiving prescribed albuterol nebulization. After
treatment, the nurse notes tremors and tachycardia. What is the best nursing
action?
A. Stop all bronchodilator therapy and notify the physician
B. Document expected side effects and continue monitoring
C. Administer a beta-blocker to counteract tachycardia
D. Provide a sedative to reduce tremors
Correct answer: B. Document expected side effects and continue monitoring.
Rationale: Tremor and tachycardia are common beta-2 agonist side effects; they usually resolve.
Continue therapy and monitor; avoid nonselective beta-blockers in COPD unless specifically
ordered and indicated.
6. Q6 — A postoperative abdominal surgery patient has an order for incentive
spirometry every hour while awake. Which teaching point should the nurse
emphasize?
A. Take slow, deep breaths in and out through the mouthpiece every 10 minutes
B. Use the device with maximal exhalation to prevent atelectasis
C. Inhale slowly and deeply to reach the target volume and hold for 3–5 seconds
D. Breathe normally through the device for 5 minutes each hour
Correct answer: C. Inhale slowly and deeply to reach the target volume and hold for 3–5
seconds.
Rationale: Incentive spirometry requires slow, deep inhalation with a sustained inspiratory hold
to promote lung expansion and prevent atelectasis; perform regularly while awake.
, 7. Q7 — A patient with chronic kidney disease has serum potassium 6.1 mEq/L and
peaked T waves on ECG. The immediate nursing action is:
A. Administer IV insulin with dextrose and prepare for Kayexalate (sodium polystyrene)
B. Arrange for emergent hemodialysis only
C. Give oral potassium supplements to stabilize levels
D. Restrict potassium intake and repeat labs tomorrow
Correct answer: A. Administer IV insulin with dextrose and prepare for Kayexalate (sodium
polystyrene).
Rationale: Severe hyperkalemia with ECG changes requires immediate measures to shift K+
intracellularly (IV insulin with dextrose) and stabilize membrane (IV calcium as ordered);
kayexalate and dialysis may be needed. Arrange dialysis if refractory.
8. Q8 — A 48-year-old woman is admitted with acute pancreatitis. Which nursing
intervention is most important in the initial 24 hours?
A. Encourage clear liquids as tolerated and advance diet quickly
B. Maintain NPO, give IV fluids, and manage pain with opioids
C. Place patient on proton-pump inhibitor and start prophylactic antibiotics
D. Insert nasogastric tube for continuous suction in all cases
Correct answer: B. Maintain NPO, give IV fluids, and manage pain with opioids.
Rationale: Initial management of acute pancreatitis includes NPO status, aggressive fluid
resuscitation, and pain control. Routine antibiotics or nasogastric suction are not universally
indicated.
9. Q9 — A client receiving heparin infusion for pulmonary embolism has an aPTT
above therapeutic range and active bleeding from the IV site. Which action should
the nurse take first?
A. Stop the heparin infusion and notify the physician
B. Administer protamine sulfate immediately per protocol
C. Apply direct pressure to the bleeding site and monitor vitals
D. Reduce the heparin infusion rate without stopping it
Correct answer: C. Apply direct pressure to the bleeding site and monitor vitals.
Rationale: Immediate physical control of bleeding (direct pressure) and monitoring are priorities.
Simultaneously notify the physician and stop heparin; protamine is given per order/protocol if
reversal indicated.
10. Q10 — A patient with newly diagnosed myasthenia gravis reports increased muscle
weakness and difficulty breathing. Which bedside test/findings would suggest
myasthenic crisis rather than cholinergic crisis?
A. Improvement of muscle strength after edrophonium (Tensilon) test
, B. Excessive salivation, miosis, and bradycardia after edrophonium
C. Lack of response to anticholinesterase and hyperreflexia
D. Immediate worsening of weakness after a dose of pyridostigmine
Correct answer: A. Improvement of muscle strength after edrophonium (Tensilon) test.
Rationale: In myasthenic crisis (under-medication), edrophonium transiently improves strength;
in cholinergic crisis (over-medication), it worsens. Edrophonium test must be done with
resuscitation equipment available.
11. Q11 — A 70-year-old male with chronic atrial fibrillation is started on warfarin.
Which instruction is most important to include in discharge teaching?
A. Take warfarin only when you feel palpitations
B. Maintain a consistent intake of vitamin K-containing foods and have regular INR
checks
C. Stop warfarin before dental visits without consulting a provider
D. Use aspirin instead if warfarin is forgotten
Correct answer: B. Maintain a consistent intake of vitamin K-containing foods and have
regular INR checks.
Rationale: Warfarin effects are affected by vitamin K intake; consistent diet and regular INR
monitoring are essential for safe anticoagulation. Never stop or substitute without provider
guidance.
12. Q12 — A patient with bacterial meningitis is started on IV antibiotics. Which
nursing intervention takes priority to reduce neurologic complications?
A. Administer antipyretics and cool blankets to reduce fever
B. Maintain a quiet, dim environment and monitor neurologic status frequently
C. Place the patient in high-Fowler’s position with neck hyperextended
D. Begin prophylactic anticonvulsants immediately
Correct answer: B. Maintain a quiet, dim environment and monitor neurologic status
frequently.
Rationale: Close neuro monitoring and minimizing stimulation control increased intracranial
pressure and detect deterioration early. Fever reduction is important but neuro checks are priority
to catch changes.
13. Q13 — A client with metastatic cancer has hypercalcemia (Ca2+ 13.2 mg/dL).
Which order should the nurse question?
A. Administer IV normal saline bolus and furosemide as ordered
B. Encourage ambulation and weight-bearing activities as tolerated
C. Give oral calcium supplements daily
D. Administer calcitonin or bisphosphonate per oncologist order
2025/2026 – advaNcEd aduLt HEaLtH
coMPrEHENSivE ExaM PrEP | HigH-YiELd PracticE
QuEStioNS witH vErifiEd aNSwErS & dEtaiLEd
ratioNaLES | PHiLiPPiNE NurSiNg LicENSurE
ExaMiNatioN (Board ExaM) SuccESS guidE
1. Q1 — A 62-year-old man with chronic stable angina reports new chest pain at rest
lasting 20 minutes. Which immediate action should the nurse take first?
A. Administer sublingual nitroglycerin and reassess in 5 minutes
B. Obtain a 12-lead ECG and notify the physician
C. Give chewable aspirin 325 mg and begin oxygen at 2 L/min via nasal cannula
D. Start an intravenous (IV) line and draw cardiac enzymes
Correct answer: B. Obtain a 12-lead ECG and notify the physician.
Rationale: A 12-lead ECG is the priority to determine ischemia/infarction and guide immediate
treatment; notify physician promptly. While nitroglycerin and aspirin are often given rapidly,
ECG to identify ST-elevation/arrhythmia takes precedence in new rest pain.
2. Q2 — A postoperative patient has been receiving opioids and reports respiratory
rate 8 breaths/min with decreased responsiveness. What is the nurse’s priority
action?
A. Stimulate the patient and continue current monitoring
B. Administer naloxone per protocol and call the physician
C. Increase supplemental oxygen to 6 L/min via mask
D. Place the patient in the lateral recovery position and observe
Correct answer: B. Administer naloxone per protocol and call the physician.
Rationale: Opioid-induced respiratory depression with bradypnea and decreased responsiveness
is life-threatening; administer naloxone per protocol and get prescriber involved. Simultaneous
airway support/oxygen may be needed.
3. Q3 — A client with type 1 diabetes is admitted with polyuria, polydipsia, abdominal
pain, and Kussmaul respirations. Serum glucose is 520 mg/dL, pH 7.18, and serum
potassium 5.2 mEq/L. What should the nurse anticipate first?
A. Begin IV regular insulin infusion after establishing IV access
B. Give oral potassium to lower serum potassium
C. Start IV 0.9% sodium chloride bolus and then insulin infusion
D. Administer sodium bicarbonate to correct acidosis
Correct answer: C. Start IV 0.9% sodium chloride bolus and then insulin infusion.
,Rationale: In DKA, aggressive fluid resuscitation with isotonic saline precedes insulin to restore
perfusion; insulin then lowers glucose and shifts potassium intracellularly. Potassium
management follows monitoring; bicarbonate is reserved for severe acidosis (pH <6.9).
4. Q4 — A patient with heart failure has sudden weight gain of 4 kg in 3 days,
increased dyspnea, and bibasilar crackles. Which intervention should the nurse
implement first?
A. Administer scheduled oral furosemide and monitor urine output
B. Place the patient in high-Fowler’s position and give oxygen
C. Restrict fluids and start low-sodium diet education
D. Call the healthcare provider for an order for IV diuretics
Correct answer: B. Place the patient in high-Fowler’s position and give oxygen.
Rationale: Acute pulmonary congestion requires immediate measures to improve oxygenation
(upright position and O2). After stabilization, diuretics (often IV) should be given promptly; call
for IV diuretics if not already ordered.
5. Q5 — A client with COPD is receiving prescribed albuterol nebulization. After
treatment, the nurse notes tremors and tachycardia. What is the best nursing
action?
A. Stop all bronchodilator therapy and notify the physician
B. Document expected side effects and continue monitoring
C. Administer a beta-blocker to counteract tachycardia
D. Provide a sedative to reduce tremors
Correct answer: B. Document expected side effects and continue monitoring.
Rationale: Tremor and tachycardia are common beta-2 agonist side effects; they usually resolve.
Continue therapy and monitor; avoid nonselective beta-blockers in COPD unless specifically
ordered and indicated.
6. Q6 — A postoperative abdominal surgery patient has an order for incentive
spirometry every hour while awake. Which teaching point should the nurse
emphasize?
A. Take slow, deep breaths in and out through the mouthpiece every 10 minutes
B. Use the device with maximal exhalation to prevent atelectasis
C. Inhale slowly and deeply to reach the target volume and hold for 3–5 seconds
D. Breathe normally through the device for 5 minutes each hour
Correct answer: C. Inhale slowly and deeply to reach the target volume and hold for 3–5
seconds.
Rationale: Incentive spirometry requires slow, deep inhalation with a sustained inspiratory hold
to promote lung expansion and prevent atelectasis; perform regularly while awake.
, 7. Q7 — A patient with chronic kidney disease has serum potassium 6.1 mEq/L and
peaked T waves on ECG. The immediate nursing action is:
A. Administer IV insulin with dextrose and prepare for Kayexalate (sodium polystyrene)
B. Arrange for emergent hemodialysis only
C. Give oral potassium supplements to stabilize levels
D. Restrict potassium intake and repeat labs tomorrow
Correct answer: A. Administer IV insulin with dextrose and prepare for Kayexalate (sodium
polystyrene).
Rationale: Severe hyperkalemia with ECG changes requires immediate measures to shift K+
intracellularly (IV insulin with dextrose) and stabilize membrane (IV calcium as ordered);
kayexalate and dialysis may be needed. Arrange dialysis if refractory.
8. Q8 — A 48-year-old woman is admitted with acute pancreatitis. Which nursing
intervention is most important in the initial 24 hours?
A. Encourage clear liquids as tolerated and advance diet quickly
B. Maintain NPO, give IV fluids, and manage pain with opioids
C. Place patient on proton-pump inhibitor and start prophylactic antibiotics
D. Insert nasogastric tube for continuous suction in all cases
Correct answer: B. Maintain NPO, give IV fluids, and manage pain with opioids.
Rationale: Initial management of acute pancreatitis includes NPO status, aggressive fluid
resuscitation, and pain control. Routine antibiotics or nasogastric suction are not universally
indicated.
9. Q9 — A client receiving heparin infusion for pulmonary embolism has an aPTT
above therapeutic range and active bleeding from the IV site. Which action should
the nurse take first?
A. Stop the heparin infusion and notify the physician
B. Administer protamine sulfate immediately per protocol
C. Apply direct pressure to the bleeding site and monitor vitals
D. Reduce the heparin infusion rate without stopping it
Correct answer: C. Apply direct pressure to the bleeding site and monitor vitals.
Rationale: Immediate physical control of bleeding (direct pressure) and monitoring are priorities.
Simultaneously notify the physician and stop heparin; protamine is given per order/protocol if
reversal indicated.
10. Q10 — A patient with newly diagnosed myasthenia gravis reports increased muscle
weakness and difficulty breathing. Which bedside test/findings would suggest
myasthenic crisis rather than cholinergic crisis?
A. Improvement of muscle strength after edrophonium (Tensilon) test
, B. Excessive salivation, miosis, and bradycardia after edrophonium
C. Lack of response to anticholinesterase and hyperreflexia
D. Immediate worsening of weakness after a dose of pyridostigmine
Correct answer: A. Improvement of muscle strength after edrophonium (Tensilon) test.
Rationale: In myasthenic crisis (under-medication), edrophonium transiently improves strength;
in cholinergic crisis (over-medication), it worsens. Edrophonium test must be done with
resuscitation equipment available.
11. Q11 — A 70-year-old male with chronic atrial fibrillation is started on warfarin.
Which instruction is most important to include in discharge teaching?
A. Take warfarin only when you feel palpitations
B. Maintain a consistent intake of vitamin K-containing foods and have regular INR
checks
C. Stop warfarin before dental visits without consulting a provider
D. Use aspirin instead if warfarin is forgotten
Correct answer: B. Maintain a consistent intake of vitamin K-containing foods and have
regular INR checks.
Rationale: Warfarin effects are affected by vitamin K intake; consistent diet and regular INR
monitoring are essential for safe anticoagulation. Never stop or substitute without provider
guidance.
12. Q12 — A patient with bacterial meningitis is started on IV antibiotics. Which
nursing intervention takes priority to reduce neurologic complications?
A. Administer antipyretics and cool blankets to reduce fever
B. Maintain a quiet, dim environment and monitor neurologic status frequently
C. Place the patient in high-Fowler’s position with neck hyperextended
D. Begin prophylactic anticonvulsants immediately
Correct answer: B. Maintain a quiet, dim environment and monitor neurologic status
frequently.
Rationale: Close neuro monitoring and minimizing stimulation control increased intracranial
pressure and detect deterioration early. Fever reduction is important but neuro checks are priority
to catch changes.
13. Q13 — A client with metastatic cancer has hypercalcemia (Ca2+ 13.2 mg/dL).
Which order should the nurse question?
A. Administer IV normal saline bolus and furosemide as ordered
B. Encourage ambulation and weight-bearing activities as tolerated
C. Give oral calcium supplements daily
D. Administer calcitonin or bisphosphonate per oncologist order
